Moderate
Bisoprolol × Indapamide
Selective beta-adrenergic blockers×Thiazide-like diuretics
Mechanism
Standard combination in hypertension – additive antihypertensive effect. Indapamide (thiazide-like diuretic) causes hypokalaemia.
Symptoms
Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk. With additional antihypertensives: bradycardia (pulse below 60/min).
Management
Standard combination. Check potassium 2–4 weeks after start and then annually. If potassium drops below 4.0 mmol/L, add a potassium-sparing component.